Provider Demographics
NPI:1851731749
Name:PARKWAY MEDICAL ASSOCIATE PLLC
Entity Type:Organization
Organization Name:PARKWAY MEDICAL ASSOCIATE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:K
Authorized Official - Last Name:RO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-337-0606
Mailing Address - Street 1:1 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3925
Mailing Address - Country:US
Mailing Address - Phone:914-337-0606
Mailing Address - Fax:914-337-6778
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3925
Practice Address - Country:US
Practice Address - Phone:914-337-0606
Practice Address - Fax:914-337-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty